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General NPI Number Information
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NPI Number | 1639424716
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Entity Type | Individual
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Provider Name | RYAN FREDERICK THEEN DC, MSN, APRN, FNP-C
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Gender | Male
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Dates
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Enumeration Date | 07/16/2012
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Last Update Date | 10/28/2020
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Provider Practice Location Address
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Address Line | 13861 MANCHESTER RD
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City | MANCHESTER
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State | MO
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Zip | 63011-4503
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Country | US
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Telephone | 636-220-9333
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Fax |
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Provider Business Mailing Address
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Address Line | 13861 MANCHESTER RD
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City | MANCHESTER
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State | MO
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Zip | 63011-4503
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Country | US
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Telephone | 618-444-8099
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 08002660A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 209021715
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 2020028106
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License Number State | MO
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